Late gastrointestinal bleeding after infrarenal aortic grafting: A 16-year experience

Paolo Bianchi, Ilias Dalainas, Fabio Ramponi, Daniela Dell'Aglio, Renato Casana, Giovanni Nano, Giovanni Malacrida, Domenico G. Tealdi

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose. To review the manifestation and management of gastrointestinal (GI) bleeding caused by secondary aortoenteric fistula (AEF) after infrarenal aortic grafting. Methods. Between 1991 and 2006, nine patients underwent emergency treatment for secondary AEF localized in the duodenum (78%), ileum (11%), or sigmoid colon (11%). Three (33%) patients suffered hypovolemic shock. There were two (22%) real fistulas and seven (78%) paraprosthetic fistulas. Graft infection was confirmed in four (45%) patients and four (45%) had proximal sterile pseudoaneurysms. Surgical management consisted of graft removal with (n = 5) or without simultaneous extra-anatomic bypass (n = 1), in situ Dacron graft interposition (n = 3), ileo-duodenorrhaphy (n = 8), sigmoidectomy with colostomy (n = 1), and segmentary ileectomy (n = 1). Endografting was used only as a temporary measure to control bleeding in two patients. Results. The mortality rate was 55% (n = 5). There were no intraoperative deaths, but 75% of the septic patients, 66% of those with preoperative hemodynamic instability, 50% of those with pseudoaneurysms, and 100% of those who required bowel resection died during the early postoperative period. Moreover, all of the surviving patients suffered early postoperative morbidity, resulting in prolonged intensive care unit stay and hospitalization. Conclusions. Secondary AEF is life-threatening, difficult to treat, and associated with high morbidity and mortality, especially in patients with sepsis or hemodynamic instability and those requiring bowel resection.

Original languageEnglish
Pages (from-to)1053-1059
Number of pages7
JournalSurgery Today
Volume37
Issue number12
DOIs
Publication statusPublished - Dec 2007

Keywords

  • Aortic pseudoaneurysm
  • Gastrointestinal bleeding
  • Graft infection
  • Infrarenal aortic grafting
  • Secondary aortoenteric fistula

ASJC Scopus subject areas

  • Surgery

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